Review of Jennifer Anne Cox, Intersex in Christ: Ambiguous Biology and the Gospel, Cascade, 2018
Intersex was once a hidden reality — but no longer (or at least not so much). The ABC show You Can’t Ask That has just shown an episode with Intersex people offering frank answers about themselves. You should watch it, to understand something of their experience. With the explosion of attention given to gay, lesbian and transgender, the “I” is often added to the LGBTQ acronym.
This awareness of Intersex people has raised all sorts of question for Christians — theological, ethical, pastoral, and maybe even political. We really needed some guidance on the issue, and so we should be thankful to Jennifer Cox, a Perth theologian who has written Intersex in Christ: Ambiguous Biology and the Gospel.
Things to appreciate
The first thing to appreciate about Intersex in Christ is that Cox writes with compassion and a clear awareness of the pain and struggles of Intersex people. Every chapter includes thoughtful, often first person, accounts of the Intersex experience; which are then engaged with thoughtful gospel reflection. Intersex in Christ is only 166 pages of text, and so cannot deal with all the complex ethical, medical and pastoral issues. I am conscious that this review skates overs these even more freely. The book itself will, however, stop you from making simplistic and thoughtless judgements in this area. It is important to be clear about principles, but also to follow them with grace, seeking God’s wisdom for specific situation.
The title points to a second strength — this is not just a theological or biblical discussion; it is Christian — focussing on redemption in Christ.
A third strength is that Cox gives excellent summaries of some of the contentious biblical, theological and ethical debates in the field and succinct responses. Some of the responses I find more convincing than others (as noted below) — but all are worth considering.
Describing Intersex
The opening chapter offers a useful review of the nature of “intersex” conditions, including tracing the possible causes and prevalence. Cox notes that clinically recognisable intersex conditions may be found in up to 0.228 percent of live births, and even a more conservative estimate would still see intersex conditions to be as prevalent as haemophilia (11). That is in cannot be ignored as if it were too rare to warrant consideration and care.
Cox records some of the heartbreak and pain associated with the condition for many Intersex people. This has been exacerbated by the common practice in the late twentieth century of early, radical surgical intervention to ‘assign’ a sex to a baby with an intersex condition. A newer paradigm has emerged in which a medical team make a careful and far slower assessment of the child. Cox favours slower and more conservative interventions which would generally leave genital surgery till adult life, unless there was a medically compelling reason to operate (22). However, she does note the view of some intersex people, especially in non-Western nations, who would have preferred to have had surgery as infants (23).
The first chapter closes with an informative survey of the personal issues which an intersex condition raises. She notes that gender identity is a fundamental issue for socialisation, and that intersex people often experience gender dysphoria — that is they come to feel uncomfortable with the gender assigned to them as an infant (often surgically). This leads on to a wider question of identity for many intersex people (27) and related stigma and shame only heightened by repeated examinations, surgery and insensitive treatment (27-31). Not surprisingly, parents of children with an intersex condition face a high level of stress and can often make their child’s experience even worse. The survey highlights the need for careful, well-informed care for intersex people and their families, from churches and medical institutions.
Cox notes that intersex conditions are often a focus of those with a radical “gender agenda” (34-37). The argument is that intersex conditions are evidence sex lies on a continuum and so assumptions about normative binary gender should be deconstructed. Cox argues against this and points out that this agenda often uses intersex people as “pawns for … political ends” (36). Historically, intersex conditions have often been presumed to be related to homosexuality, but this is a false assumption (37). More recently, they have been connected with transgender. Cox maintains that there is a clear distinction between biology and psychology. So “intersex, homosexuality and transgender are three separate matters” (38).
Theology and Intersex
The bulk of Intersex in Christ consists of chapters dealing with creation, the incarnation, the cross and the resurrection, and applying important insights to the discussion of Intersex.
Creation and sin
Chapter 2 emphasises that we are embodied creatures, made in God’s image and argues that God’s image is fundamentally relational: to be the object of God’s grace and to give to others (42). That’s not the best definition of “the image of God”, or a full basis for theological anthropology, but it is a good starting point. Cox affirms, importantly, that “all humans, however sexed, are created in the image of God” (43) and that “having a body is good” (44).
Cox is also aware that bodies can go wrong. The fall means that “the world is broken by sin”, though this does not remove “the goodness given … by God”. Congenital defects, including intersex conditions, are one of the manifestations of brokenness and physical death (46). She notes that congenital defects particularly highlight the communal impact of sin: “we all experience the consequences of humanity’s sin, even before we are born, due to our intrinsic connection to other humans” (46). An intersex person is not born so because of their own sin — “it is the result of every person’s sin” (47).
Human embodiment remains good after the fall. This is an important point to make, since intersex people can often feel that their bodies are not good.
Cox considers arguments that humanity is not made “male and female” and concludes that they do not agree with the presentation of Genesis 1-2 (50-53). Intersex cannot be considered a third sex or a third gender, nor can we conclude that gender is on a continuum (57). Rather intersex conditions are one of a number of ways in which human sexuality is affected by the fall.
Cox looks at five women in Jesus’ ancestral line who did not conform to sexual norms: Sarah and Ruth who were unable to bear a child (Gen 16:1; 18:11; Ruth 1:4); Tamar a rape victim (Gen 38); Rahab the prostitute (Josh 2:1) and Bathsheeba (2 Sam 11:1-5). She does not draw direct parallels with intersex; though she notes that some Rabbis thought Sarah did not have a womb and was tumtum — a term for intersex (60). Rather, the point is that “if these women of unusual sexuality can be so significantly used of God, then there is no reason why people who are intersex cannot expect to be used by God, if they are people of faith in Jesus” (62).
In chapter 3, Cox turns to deal directly with contemporary views of gender. She notes the appeal of gender fluidity and the desire to remove the “binary gender construct” — mainly drawing on Viringia Mollenkott’s Omnigender: A Trans-Religious Approach (2007). She states clearly that her evangelical Christian convictions mean that she “cannot endorse the idea that we should do away with male and female, nor … that gender is fluid” (67). Much of the chapter sets out her case for this.
While I agree with Cox’s conclusion, I’m not convinced that she gives the best case for it. Her Trinitarian argument is that humans reflect the ‘unity-in-distinction’ and ‘distinction-in-unity’ as the Trinity. So why not three sexes? Cox suggests that is because the Spirit is the perfect shared love of the Father and the Son; and the Spirit gives the gift of love to unite men and women, in marriage and in community built on it (72). The need to appeal to Trinitarian speculation is a warning that we can’t see gender difference grounded in the Trinity.
This argument naturally leads Cox also deals with the question of whether God has a sex or gender. She agrees with the tradition that he does not, argues that “since humans are created in God’s image, there must be something in God that corresponds to sex or gender”. Again, I don’t think much is gained in exploring ungrounded analogies. It is more than sufficient to affirm that binary gender is part of God’s good creation order.
Cox offers a better argument from biblical eschatology. Marriage points us to our destiny of union with God as his people. And it can only do so as people are created male and female — so binary gender is important in God’s purposes.
Redemption in Christ
The next chapters consider how human sex and gender relate to redemption in Christ. She confronts feminist theological objections to God’s incarnation as a man. She makes the important point that this is not to claim that God the Son is male — we cannot project the maleness of Jesus back into the Godhead (76). Second, Jesus being male does not mean that he can only represent males, the New Testament emphasises Jesus humanity, not his masculinity. As she points out, Jesus masculinity is part of the ‘scandal of particularity’ — the Son came as a Jewish male in the 1st century, born to Mary — “we have no right to decide that we would like this to be otherwise” (76).
In this discussion she turns to question of male and female roles and argues that complementarianism is difficult for intersex people because it requires them to determine which sex they are, before they can fully participate in church life. This may be so — I can see that a church culture which is concerned about gender roles might increase the difficult of a person whose sex is ambiguous. That is not, though, a defeater for complementarianism.
It is at this point that I would most strongly qualify Cox’s view, though in practice we may not be far apart. Part of her pastoral and ethical advice to people with an Intersex condition is that they do not have “to choose” which sex they are. “The only definitive reason that would require an intersex person to adopt male or female is when entering marriage” (89). Though she recognises that practically it is often easier for someone to live as male or female. This can be done without surgical treatment but can be a difficult decision and “the first choice may not be the best one” (89). A person may transition from one to another.
Cox is clear that there is no ‘third sex’ and the God’s design is for humans to be male or female. Her point is that where that where biological differentiation has gone wrong leading to an intersex condition a person may be content to present as Intersex, without fitting the binary pattern.
To some extent, I can appreciate how difficult it is to be told that you must ‘choose’ a sex — and assigning sex to infants has led to heart-breaking pain for Intersex people. Yet, God’s pattern is binary sex (as Cox agrees). So, it seems best to seek to determine which sex the person is and help them to live according to that sex. The process to reach this decision and the decision itself will vary from person to person, depending on the details of their condition and on their life history. Some intersex conditions may leave a person in a position in which they must simply choose, but in the vast majority of cases the mix of genes, genitals, secondary characteristics, and personal history will be determinative.
There are two general scenarios which need to be considered. The first is the child who at birth has ambiguous genitalia. The wise course here seems to be to allow time for the child to develop both physically and socially before considering any surgical intervention. Each child and family need help to develop an appropriate response. The other scenario is where an adult (or teen) discovers that they are intersex. Sometimes this includes the discovery that they had sex assignment surgery as an infant. 1 In most cases, the wisest course is for them to continue to live as the sex which they have had growing up — though there may be some unusual cases where this is not the best course.
Chapters 4 & 5 relates Jesus’ life to Intersex conditions, highlighting how Jesus shares in the suffering of the human condition and offered forgiveness, salvation and a new identity to sinners, including those on the edges of society (100-19).
Cox considers and dismisses the argument that Jesus was intersex, since he was the product parthenogenesis (virgin birth). She rightly points out that the Virgin birth is not an explanation of the mechanism of Jesus’ conception (just as the resurrection is not a biological explanation). The incarnation is significant because in it the Son enters the human condition and becomes the representative head for a new humanity constituted of men and women (99).
Intersex people, and others with disabilities, would have been excluded from the temple (Lev 21:20; 22:24; Dt 23:1), and the restrictions were probably stronger in the 1st C. Christ opened way into the new temple for all (122-24). Cox argues that Jesus death heals broken human sexuality (Eph 5:25-27) since sex is primarily about relationships, so in restoring us to God “Jesus … healed all that is broken in regard to sex, gender, and human sexuality” (125). This would be a thin view of redemption but that the next chapter turns to the resurrection.
Chapter 6 argues that sexuality will be preserved but transformed in the resurrection. Resurrection is physical, but our bodies are transformed “our bodies will be bodies still, but bodies of a different kind … with a greater glory than anything we can presently imagine. (132). Resurrection offers hope (147)
In this discussion, Cox reviews the arguments of Megan DeFranza, Sex Difference in Christian Theology: Male, Female, and Intersex in the Image of God Eerdmans, 2015 and Susannah Cornwall, Sex and Uncertainty in The Body of Christ: Intersex Conditions and Christian Theology Routledge, 2016. Both argue from the resurrection that Christians can question, or adandon, the binary structure of ‘essentialist’ views of sex and gender. DeFranaza argues that diverse sex will be included in resurrection bodies so in Christ it is irrelevant if a person is male, female or intersex. Cornwall questions the idea of healing intersex conditions in resurrection. No healing is needed, and Jesus was raised with his wound. How can a person with, say, a mosaic genetic condition be the same person if that is changed? Jesus was raised with wounded body — we can affirm our own limited bodies
Cox’s reply, in brief, is that resurrection affects the whole person, not just perceptions and relationships (133). She insists that sin has changed the creation and effected all our bodies “no bodies … are perfect now … every body dies and needs healing in the resurrection”. So there will be continuity of in the resurrection identity but also glorification — which could include genetic changes. (Cox wisely refuses to speculate about the biology of resurrected bodies). She points out that Jesus carries his wounds but also “was crucified in weakness, yet he … by God’s power” (2 Cor 13:4).
In this discussion she also considers Matthew 22 where Jesus teaches that there will be no marriage in the resurrection. She affirms the classic Christian view that humans will be raised as men and women. Intersex person will be raised with healed bodies “restored to male or female” (140) as all find a transformed identity in Christ.
Cox argues that the resurrection affirms the goodness of bodies and so the value of restoration, including restorative surgery. In contrast cosmetic surgery is often about making bodies ‘look’ better, which doesn’t affirm the goodness of the body. She argues that intersex conditions do not necessarily require surgery or hormone treatment — unless it is to protect consequences which can impair function; question is about enhancing well-being (144). I think her approach here is wise, though I’d argue that the eschatology suggests that healing bodies where possible is a good act. It’s just that we often lack the ability or the wisdom to know what is truly restorative.
Finally, Cox deals with sexual ethics. She notes that Intersex people may not be able to have sexual intercourse (due to malformed genitals or scarred by treatment), but may have a sexual relationship, and that must be ordered by Christ. She affirms that the classic Christian sexual ethic in which sexual activity is only proper in heterosexual marriage applies to intersex people. So, her position is that they should marry according to their gender. This may be straight-forward for some, but not for all. She insists that is not appropriate to transition after marriage (152).
The book concludes with a call to the church to move from fear of Intersex people to welcoming and valuing them in Christ.
I’ve noted some of my points of disagreement, but overall Intersex in Christ is a helpful and stimulating read.
Postscript — another review
After writing this review, I came across an earlier review on Intersex in Christ by Lianne Simon, an intersex Christian. She warns that she is too close to the issue to be “entirely unbiased”, but that’s what makes it such an important review.
She likes that Cox stresses
- that the Gospel is as much for someone with an intersex condition as it is for anyone else;
- that Intersex bodies are fine the way they are (which isn’t quite what Cox says — she says bodies are always good, and everyone’s body is broken)
- that being unambiguously sexed dosen’t make you any more in God’s image
- that Intersex believers “are acceptable to God without alteration”
- that determining an Intersex persons ‘sex’ is far more than a matter of chromosomes
- that it’s OK to remain in the sexual identity as Intersex in which someone came to Christ
She isn’t sure about some of Cox’s statement.
- She wonders if resurrection bodies will be sexed, or restored to binary sex and is not so convinced that intersex will be erased in the New Creation. She makes the point clearly, and it made me think further: “If I rise from the dead with a completely female body, I won’t complain. It would seem odd to me, however, to suddenly have a functional reproductive system in a place where such will never be used …If I rise from the dead with a completely male body, I won’t complain. But my gender would also need to change.
- She points out some places which Cox still isn’t sensitive enough to the trauma of Intersex people, so would not give this book to a non-Christian.
- While she appreciates that Cox quotes from Intersex people, Simon notes that she doesn’t have a close relationship with any Intersex people. And she doesn’t know some of the scholars and medicos who Simon knows, trusts and respects.
- See Sara Gillingham’s story, “My intersex story” Church Times 22 February 2019